Planned Parenthood barred from Title X under final draft rule

(Updated at 2:35 p.m. ET)The Trump administration on Friday released its draft final rule that would bar Planned Parenthood affiliates from the roughly $290 million in funds for the federal family planning network known as Title X, and prohibit any clinic from referring a patient for an abortion unless the patient directly asks.

Planned Parenthood President Dr. Leana Wen warned the group would fight the rule "through every avenue" including litigation.

A similar rule put in place by President Ronald Reagan was upheld by the U.S. Supreme Court.

The draft final regulation from HHS' Office of Population Affairs, or OPA, is even stricter than the original proposal from last May that roiled women's reproductive health groups. It is set to bar the grant money from any clinic that performs abortions—the key provision that impacts Planned Parenthood.

"This rule will require Title X providers to maintain physical and financial separation from locations which provide abortion as a method of family planning," the document stated.

The OPA published the draft final rule on Friday afternoon. It is slated to go into effect 60 days after a final signoff and posting to the Federal Register.

Further, HHS said the change addresses "concerns over the fungibility of Title X resources and the potential use of Title X resources to support programs where, among other things, abortion is a method of family planning."

While abortion referrals are permitted as long as a patient asks, they aren't required.

"With respect to conscience, the regulatory requirement to counsel on abortion, if requested, conflicts with HHS enforced statutes protecting conscience in health care," HHS said.

The rule tightens reporting requirements. Network grantees would have to document that they are complying with state and local laws about reporting child abuse or molestation, sexual abuse, rape, incest, domestic violence or human trafficking.

It also makes birth control available for free or low cost to people whose employer-sponsored health plan doesn't cover contraception based on religious objections.

Next steps for the Title X network aren't clear as Planned Parenthood and other interested parties eye a lawsuit.

Wen told Modern Healthcare that Planned Parenthood, which currently serves 41% of the people in the Title X network, has been planning its next steps for months while waiting for the rule to come out.

"We want our patients to know that our doors our open, and we will be here for them," she said.

Along with myriad other provider groups, she also blasted the regulation as a direct interference in the practice of medicine through its ban on abortion referrals known as a "gag rule."

"It's unprecedented that politicians could specifically tell doctors and nurses what we can and can't say to our patients," she said.

Clare Coleman, CEO of the National Family Planning & Reproductive Health Association that represents many current Title X grantees, warned in a statement that the final rule will do "irreparable harm" to public health and interferes with the patient-physician relationship.

"This rule jeopardizes the foundation that our nation's family planning providers have built and sustained for nearly 50 years," Coleman said. "This clear attack on family planning care could result in lower quality care or none at all for people struggling to make ends meet."

The anti-abortion group Susan B. Anthony List, a driving force behind the regulation, applauded the release of the revised language.

"We thank President (Donald) Trump for taking decisive action to disentangle taxpayers from the big abortion industry led by Planned Parenthood," SBA List President Marjorie Dannenfelser said.

She also praised the rule for keeping the overall funds intact while cutting out abortion providers.

"We thank President Trump and Secretary (Alex) Azar for ensuring that the Title X program is truly about funding family planning, not abortion."

Meanwhile, Democratic attorneys general who vocally criticized the proposed rule are also eyeing a legal challenge.

California Attorney General Xavier Becerra met earlier this month with the Office of Management and Budget to voice his opposition as one-quarter of the people expected to be impacted nationwide live in his state.

This final draft follows a roller-coaster year for the existing Title X network. Last August, HHS announced that the network would largely remain status quo, with 12 additions including Planned Parenthood affiliates.

In November, months after retooling the funding criteria for the program, the administration clarified that every recipient of the grants must include a provider that offers hormonal birth control.

Last week, key lawmakers including House Committee on Oversight and Reform Chair Elijah Cummings (D-Md.) and Senate health committee ranking member Patty Murray (D-Wash.) wrote a letter to the administration that sharply criticized the regulatory review process for the rule.

The letter was addressed to OMB Director Mick Mulvaney, who is also acting chief of staff for the White House, and Office of Information and Regulatory Affairs Administrator Neomi Rao. The Office of Information and Regulatory Affairs did the final review and signoff of the rule after OMB cleared it on Feb. 7.

"In particular, we are concerned that OIRA may soon approve the final rule for publication without ensuring that the Department of Health and Human Services (HHS) has conducted a comprehensive cost-benefit analysis of the rule's potential economic and health impacts," the lawmakers wrote.